Gastrointestinal Flashcards
(182 cards)
1
Q
Bechet syndrome triad
A
Recurrent oral aphous ulcers
Genital Ulcers
Uveitis
2
Q
Aphthous ulcer is composed of
A
FNAC: exudate and granulation tissue like an ulcer
3
Q
2 precursor lesions of sq cell carcinoma of mouth
A
Leukoplakia
Erythroplakia and Hairy
4
Q
How to differentiate Leukoplakia, thrush and hairy leukoplakia
A
Leukoplakia cannot be scraped away (thrush can)
Hairy leukoplakia is on LATERAL tongue and is hairy looking
5
Q
3 organs affected by mumps
A
Bilateral parotids
Orchitis
Pancreatitis
6
Q
Siladenitis presentation
A
unilateral/bilateral parotid swelling
7
Q
Siladenitis cause
A
Parotid stone –> S. aureus infection
8
Q
Pleomorphic adenoma components
A
Stroma (cartilage!) and epithelial tissue –> BIPHASIC
9
Q
Pleomorphic adenoma recurrence rate
A
High b/c it has irregular borders –> incomplete resections
10
Q
Cystic tumor with lymphoid tissue and germinal centers in the parotid
A
Warthin tumor (recall smoking and men)
11
Q
TE fistula presentation (4)
A
Vomiting and coughing with FIRST FEEDING
Abdominal distension
Polyhydramnios
12
Q
Esophageal web is a protrusion of which layer
A
Esophageal mucosa only
13
Q
Esophageal web presentation
A
dysphagia for solids
14
Q
Zenker diverticulum layers
A
Mucosa only (false diverticlum)
15
Q
Zenker location
A
b/w upper esophageal sphicnter and pharynx
16
Q
Zenker presentation
A
Halitosis
“feels like lump in throat”
Dysphagia
17
Q
Painful hematemesis in bullemic or alcoholic
A
Mallory Weiss
18
Q
Mallory weiss defect
A
longitudinal of mucosa at Gastroesophageal junction
19
Q
Subcutaneous emphysema w/ shoulder pain
A
Borhaave syndrome –> ruputred GE junction
20
Q
Usually Painless and Massive hematemesis of bright blood
A
Ruptured esophageal varicies
21
Q
Dysphagia for solids + liquids with halitosis
A
Achalasia
22
Q
Achalasia underlying defect
A
No ganglion cells in myenteric plexus = no relaxation
23
Q
Imaging findings in Achalasia
A
Dilated esophagus
Increased LES pressure
24
Q
infectious cause of achalasia
A
Trypanasoma cruzi
25
HIatal hernia
Cardia of stomach herniates into esophagus--> GERD
26
Paraesophageal hernia
Cardia herniates lateral to esophagus, above diaphragm
27
"bowel sounds in the lung fields" is characteristic of
Hiatal hernia
28
Classic GERD presentation
Heartburn
| Persistent cough
29
late complication of GERD
Ulceration w/ stricture or adenocarcinoma
30
what causes strictures in GERD
acid=esophagitis = fibrosis
31
specific cell changes that occur in Barrets Esophagus
Non Keratinized Stratified Squamous epithelium --> Non ciliated columnar epithelium w/ goblet cells
32
Adenocarcinoma of esophagus location
lower 1/3
33
3 major risk factors for adenocarcinoma
GERD risk factors
| Hiatial Hernia
34
Sq Cell carcinoma of esophagus location
Upper 2/3
35
3 classic presentations of esophageal cancer
Dysphagia for solids that progresses to liquieds
Hematemesis
Weight loss
36
Sq cell carcinoma has which unique symptom
Hoarseness and cough
37
cancer in upper 1/3 mets to which nodes
cervical nodes
38
cancer in lower 1/3 mets to
celiac / gastric nodes
39
Middle 1/3 mets to
mediastinal / tracheobronchial nodes
40
failure of the lateral folds of the ventral wall causes
Gastroschisis (not covered by peritoneum)
| Omphalocele
41
Omphalocele is a failure of
Bowel to return to abdominal cavity from umbilical cord
42
non billous vomiting several weeks after birth + abdominal mass
Pyloric stenosis
43
Sever hypovelmia causing an ulcer is called
Curling ulcer
44
2 mechanisms by which NSAIDs cause gastritis
Decreased PGE2 = More acid, less mucus
45
Increased intracranial pressure causing ulcers is called
Cushing ulcer --> increased vagal stimulation = increased acid
46
erosion vs ulceration
erosion - epithelium only
| ulceration = entire mucosa and beyond
47
autoimmune gastritis is which type of hypersensitivity
TYpe IV
48
where are parietal cells located
boidy and fundus
49
4 features of pernicious anemia
Mucosal atrophy
Achlorhydria
Megaloblastic anemia
Intestinal type gastric cancer
50
H pylori affects which area
pylorus, antrum
51
2 cancers H pylori increases risk for
```
Intestinal type adenocarcinoma
MALT lymphoma(marginal zone)
```
52
2 tests to determine presence of H.pylori
+ urea breath test
| Ag present in stool
53
Histology of H pylori
The align the mucosal cells but do not invade
54
Type of ulcers caused by h pylori
duodenal
55
How to differentiate b/w gastric and duodenal ulcer in HPI
duodenal = improved pain with meals (bicarb secreted)
Gastric = worse with meals (acid secreted)
56
2 complications of posterior duodenal ulcer rupture
gastroduodenal artery rupture
| Pancreatitis
57
2 complication of gastric ulcer rupture
Left gastric artery rupture (on lesser curvature)
| Intestinal type adenocarcinoma
58
3 risk factors for intestinal type gastric cancer
Chronic gastritis from any cause
Bllod group A (type A for cA)
Nitrosamines in bbq food
59
2 features of diffuse type gastric cancer
Signet ring cells
| Desmoplasia --> linitis plastica
60
Patient develops tons of seborrhic keratoses within a week and acanthosis nigracans...suggestive of?
Gastric cancer
61
Left supraclavicular node enlargement is suggestive of
GI cancer...particularly Gastric
62
lymph node affected by intestinal type
periumbilical node
intestines are near the umbilicus
63
Bilateral ovary metastisis is common in which type of gastric cancer
diffuse
| will see signet ring cells in ovary
64
billous vomit with duodenal distension
duodenal atresia
65
2 conditions associated with down syndrome
Duodenal Atresia
| hirsprungs
66
meckel diverticulum layers
TRUE diverticulum. all layers are involved
67
2 embryonic correlations to meckel diverticulum
Persistent omphalomesenteric duct
| Persistent viteline duct
68
most common cause of painless hematochezia in kids? adults?
Kids- meckel
| Adults- diverticulosis
69
General rule for infarction/bloody diarrhea
Infarction = Bloody diarrhea!
70
2 MCC sites of volvulus
sigmoid in adults
| cecum in kids
71
2 MCC of intususseption in kids
```
lymphoid hyperplasia (viral infection)
Meckel divertisulum
```
72
Small bowel infarction ssx (3)
GENERALIZED abdominal pain
Bloody diarrhea
Decreased bowel sounds
73
Transmural vs mucosal small bowel infarcts (cause)
Transmural = thrombus
Mucosal = hypotension (same logic as subendocardial ischemia)
74
lactose intollerance pathogenesis
Lactase deficiency (disaccharidase, brush border ensyme)
75
Lactose intolerance biopsy
Normal!
76
Celiac dz HLA types
HLA DQ2 and DQ8
"i 8 2 much gluten at Dairy Queen"
77
3 Celiac auto Ab
IgA agasint gliadin
IgA against endomysium
IgA agasint tissue transglutaminase
78
Inflammatory cell responsible for tissue damage in celiac
CD4 T cells reacting to deamidated gliaden
79
Skin association w/ celiac
dermatitis herpetiformias
80
histology cause of dermatitis herpetiformis
IgA deposition at top of dermal papillae
81
3 features of biopsy in celiac
Flat villi
Crypt hyperplasia
Increased lymphocytes
82
area of bowel most affected by celiac
Duodenum
83
Cancer celiac pts are at increased risk for
T cell lymphoma...unique b/c most lymphomas are B cell
84
how to identify tropical sprue
same ssx as celiac but occurs in tropical region
85
Tropical sprue vs celiac zones of damage
```
Celiac = duodenum (fe def)
Sprue = jejunum (folate def) and ilium (b12 def)
```
86
Fever, steatorrhea, joint pain, swollen lymph nodes
Whipple dz
87
Histology of whipples
PAS + foamy macrophages
88
Why does whipple cause steatorrhea
Macrophages compress lacteals --> fat mal absorption
89
3 extraGI sites that whipples affects
Cardiac valves
Arthritis (joints)
Nodes (lymph nodes)
"WHIPped cream in a CAN"
90
most common layer of GI wall affected by whipple
Lamina propria
91
Carcinoid tumor histology and stain
neurosecretory granules --> Chromogranin +
92
most common sites for primary carcinoid tumors
```
Terminal Ileum (will metastasize)
Tip of appendix (won't metastasize)
```
93
Labs for carcinoid tumor
Increased 5Hydroxyindolacetic acid (b/c serotonin is metabolized by MAO)
94
Why does metastasis to liver cause carcnoid syndrome
bypass metabolism of serotonin by MAO
95
4 SSx of carcinoid syndrome
Flushing of skin
Diarrhea
Tricuspid insufficiency
Pulmonic valve stenosis
96
MCC of appendicitis in kids vs adults
```
Kids = lymphoid hyperplasia (just like intussuption)
adult = fecalith
```
97
UC vs Chrons wall involvement
UC- mucosa/submucosa
Chrons = full thickness
98
UC vs Chrons location in GI
UC- colon only. loves the rectum
| Chrons- Anywhere. Terminal ilium > Anus > Rectum
99
UC symptoms
LLQ pain with bloody diarrhea and urgency
100
Chrons symptoms
RLQ colicky pain (b/c transmural inflammation)
| +/- blood
101
UC histology
Crypt abscesses with neutrophils
"Crypt for uC"
102
Chrons histology
Granulomas full of TH1 cells
103
UC vs Chrons gross appearance
UC- loss of haustra
Chrons- Creeping fat + strictures =string sign
104
2 major GI complications of UC
Toxic megacolon
| Cancer
105
4 major GI complications of chrons
Malabsorption (B12, fat, vitamins)
Calcium oxalate stones
Gallstones (decreased bile acid resorption)
Fistula formation (peeing air!)
106
4 extraintestinal manifestations of BOTH IBDs
Rash (pyoderma gangrenosum)
Uveitis
Apthous ulcers
Seronegative spondyloarthritis
107
Unique extraintestinal complication of UC
Primary Sclerosing Cholangitis (p-ANCA)
108
smoking protects against
UC
109
hirshbrung defect
Failure of ganglion cells to descend into myenteric/submucsal plexus --> no VIP = no relaxation
110
Where do ganglion cells derive from?
Neural crest
111
3 clinical features of hirsprung
Failure to pass meconium
Empty rectal vault + mega colon
Explosive diarrhea after DRE
112
specifically, where do colonic diverticula arise?
Muscularis propria where the vasa recta enters
113
DDx for pneumaturia or stool in urine
Chrons or Diverticulosis
114
Angiodysplsia location and population
Right side of colon
Old people
115
hereditary hemorrhagic telangiectasia defect
Thin walled blood vessels in mouth / GI tract
116
HHT SSx
Telangectasia on lips
| Diarrhea
117
HHT inheritance
Autosomal Dom
118
Ladd bands
FIbrous bands that connect colon and liver. Seen in malrotation
119
Malroation embryonic problem
Failure of midgut rotation
120
Malroation predisposes to
Volvulus / duodenal obstruction
121
Are adeonmatous polyps beign or malignant
Benign
122
how do adenomatous polyps become cancer
Adeonma- Carcinoma sequence
123
Adematous Polyposis Coli (APC) Gene mutation
Increased RISK of polyp
124
Which mutation leads to formation of polyp?
KRAS
125
2 mutations that cause polyp to become carcionma
Decrease p53
| Increase COX2
126
which medication can help prevent movement from polyp to carcinoma?
ASA...inhibit Cox2
127
most dangerous growth pattern for a polyp
Sessile growth > Pedunculated
128
most dangerous histology subclass of polyps
Villous
"Villous is the Villan"
129
Familial Adematous Polyposis gene mutation and chromsome
APC mutation on Ch 5
"Familial on 5"
130
FAP inheritance
AD
131
osteoma, retinal defects, nasty teeth and FAP
Gardner Syndrome
"Gardeners get bone pain from being on their knees. Retinal defects from being in the sun, and bad teeth from all that chew"
132
FAP with medullablastoma or glioblastoma
Turcot Syndrome
"Turcot sounds like turban. Turbans go on heads"
133
Prolapsed mass in coming out of a kids butt
Hamartoma
134
Hyperpigmentation of lips and genitals + polyps in stomach and small intestine
Peutz Jeghers
135
Peutz Jeghers inheritance
AD
136
pathway by which right sided colon cancers arise
Microsatelite instability path
"MicRo is Right" or "RIGHTcro"
137
Microsattelite instability pathway defect and pathogenesis
CpG hypermethylation --> failed DNA repari
138
Family history of colorectal, breast, endometrial cancer
Hereditary nonpolyposis colorectal carcinoma
139
HNPCC mutation
DNA mismatch repair enzymes --> tumors arise from microsattelite instability pathway (right)
140
pathway by which left sided cancers arise
Adenoma Carcinoma Sequence
"Firing an AK53" APC --> KRAS --> p53
141
Left sided colon cancer SSx
Decreased stool caliber
+/- blood streaked stool
LLQ pain
142
Right sided colon cancer SSx
Fe deficiency anemia
Occult Blood
Vague pain
143
Most common site of metastasis for colon cancer
Liver
144
Serum tumor marker for colon cancer and its use
CEA. Used to measure for recurrence
145
How to differentate pure esophageal atresia from TE fistula + atresia
TEF+Atresia leads to air in the stomach on CXR
Pure atresia will be lacking that because there is no communication with the trachea
146
Position of gastroesophageal junction relative to diaphragm in a hiatal hernia
GE junction shifts upwards
147
Position of gastroesophageal junction relative to diaphragm in paraesophageal hernia
Normal. Only problem is the fundus of the stomach is in the thorax
148
Embryologic defect that predisposes to hiatal hernias
Defective pleuroperitoneal membrane
149
How to differentiate mallory weiss from borehave histologically
Mallory weiss is only mucsosal tears
| Borehave is transmural`
150
Pt with reflux symptoms that has not improved with a PPI. He has a history of asthma. Dx?
Eosinophilic Esophagitis
151
Which risk factor increases risk for both squamous and adenocarcinoma of the esophagus
Smoking
152
Failure of the caudal ventral wall to fuse in utero
Bladder extrophy
153
type of hypersensitivity rxn in pernicious anemia
Type IV
154
histology shows mucin filled cells with peripheral nuclei
Signet Ring Cells
155
Which gland type is hypertrophied in duodenal ulcers?
Brunner Glands --> benign
156
Pt with hx of epigastric pain that improves with eating presents with severe abdominal pain and shoulder pain. CXR reveals air under the diaphragm
Perforated duodenal ulcer
157
Imaging shows hypertrophied rugae of the stomach with excess mucus production
Menetrier Disease...rugae look like brain gyri
158
Menetrier Disease defect
Excess mucus production leading to protein loss and parietal cell atrophy --> achlorhydria
159
Patient has small bowel infarction, then develops abdominal pain, flatulence and diarrhea when he drinks milk. Why?
Lactase is very sensitive to ischemia, so patients with abdominal ischemia or trauma often have temporary bouts of lactose intolerance
160
Celiac and IgA deficiency often occur together. What is the serum marker for celiac if someone is IgA deficiency?
IgG Ab against gliaden, tTG and endomysium
161
Main complication of pyloric stenosis
Metabolic alkalosis (hypokalemic, hypochloremic)
162
Best initial test to confirm the presence of malabsorption in a patient. Not necessarily the specific cause
Sudan stain for fecal fat
163
Besides dermatitis herpetaformis, what is a major extraGI manifestation?
Low bone density
164
Basis of the D-xylose test
Xylose should be reabsorbed in proximal small intestine (blood and urine levels will increase)
165
Xylose test in Celiac
Blood and urine xylose levels will be low because you cant reabsorb it (villi are all destroyed)
166
3 Lactose intolerance screening tests
Elevated hydrogen breath test
Acidic stool
Increased stool osmoality
167
Why is the stool acidic in lactose intolerance/
Bacteria convert lactose into short chained fatty ACIDS (which also release H+ and cause a positive breath test)
168
Abdominal distension and diarrhea with a megaloblastic anemia. Improves with Antibiotics
Tropicle sprue
169
What 2 substances to enteric bacteria produce?
Vitamin K and Folate
This is why neonates can develop vitamin K deficiency! They don't have gut flora yet
170
What 4 things do enteric bacteria consume
Vitamins A,D,E
B12
Iron
Bile Salts
171
Who is bacterial overgrowth most often seen in
Bypass surgery patients
172
Patient presents with sudden onset severe epigastric pain. PE is unremarkable and no abnormal imaging findings. Diagnosis?
Acute mesenteric ischemia
"Pain is out of proportion to physical findings"
173
DDx for failure to pass meconium. How to differentiate between them?
```
Meconium Ileus (CF) --> no stool after DRE
Hirshprungs --> Explosive stool after DRE
```
174
SSx of bowel obstruction
No flatulence or bowel movements
Tympanic to percussion
Decreased bowel sounds
175
Intermittent vomiting, abdominal pain and obstruction in a child that spontaneously improves, then happens again. Imaging shows improper positioning of the large bowel and fibrous tissue connected to liver
Malrotation (Ladd Bands connect colon to liver)
176
Malrotation embryo defect
Abnormal midgut rotation
177
2 complications of malrotation
Volvulus
| Duodenal obstruction
178
Streptococcal gallolyticus is associated with
Endocarditis in colon cancer (formerly called S. bovis)
179
MLH1 mutation
HNPCC
180
What is another name for the adenoma carcinoma sequence?
Chromosomal instability pathway
181
Premature infant with fever, bloody diarrhea and abdominal distension and free air in the abdominal cavity
Necrotizing enterocolitis
Abdominal xray looks like monkey bread w/ all the air in there
182
Necrotizing enterocolitis most commonly happens in which types of infants
Purely formula fed babies
